Provider Demographics
NPI:1588903124
Name:MACGILLIVARY, TESSA KATHERINE (MS)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:KATHERINE
Last Name:MACGILLIVARY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:KATHERINE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 NORTHEASTERN BLVD UNIT 28
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3174
Mailing Address - Country:US
Mailing Address - Phone:603-402-1999
Mailing Address - Fax:
Practice Address - Street 1:76 NORTHEASTERN BLVD UNIT 28
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:603-402-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6982101YM0800X
NH707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health